Three-Campus Comparative East Asian Studies Program
Common Application Form
ATTACH PHOTO
HERE
(taken within 6 months,
3cm x 4cm, color, glossy)
Instructions:
A)
B)
C)
D)
1.
Application should be typewritten or PRINTED in block letters.
Year should be written in dominical year.
Proper noun should be written in full, and not be abbreviated.
Check the appropriate boxes.
Full Name
Family Name
First Name
Middle Name
English Alphabets
Do not use characters with
accent marks (e.g. ą, ç, ë) *1
Katakana or Hiragana
Chinese Character
Required for all Chinese and
Korean nationals
*1 Our information system does not recognize characters with accent marks
2.
Date of Birth
(yy/mm/dd)
3. Nationality/All Nationalities
Write all nationalities if you hold multiple nationalities.
19 ×× /
4.
mm
/ dd
Age
Sex
Male
5.
Female
Marital Status
Single
Married
6. Passport Number
.
7. Home Institution
Name of your home institution
Faculty /Graduate School
Expected date of graduation (upon completion of 3 campus
program)
20 ×× / mm / dd
Major
Overall GPA
Minor
Semester &/Year at Home Institution
TOEFL / IELTS Score
Out of *4.0 / 4.3
8. Present Contact
Present Address
Tel. +
E-mail
Effective from mm/yy
– to mm/yy
Fax. +
9.Permanent Contact
Same as above
Permanent Address
Tel. +
E-mail
Effective from mm/yy – to mm/yy
Fax. +
10. Emergency Contact
Relationship
Full Name
Address
Tel. +
E-mail
Fax. +
11. Education (From primary education to present)
Name of Institution
Location
Degree
Period (yy/mm)
/
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～
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/
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/
Years attended
12. Application Materials
A.
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Common Application Documents
*Please submit one original and two copies of the following documents to your home university.
1. Common Application form with one Official ID Photo (attached, 4cm X 3cm, NO COLOR COPY)
2. One letter of recommendation from a professor at your home university
3. Official transcript * Must show at least two semesters’ grades at the time of application
4. One passport copy
5. Letter of nomination by home university
B.
Registration Documents Specific to Each University
*Please submit one original of the following documents to your home university.
i)
For Keio University
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1. Complete Online Registration
2. Study Proposal
3. Self-evaluation Sheet for Japanese Language Proficiency
4. Certificate of Health
5. Three official ID Photo (4cm x 3cm)
Visa Documents
□ Send Application for Certificate of Eligibility (3 pages) to ic-coe@adst.keio.ac.jp
□ Certificate of Financial Support
ii)
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□
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For Yonsei University
1. Complete Online Application Form
2. Study Plan (Statement of Purpose, A4 letter size, minimum 250 words)
3. Proof of Medical Insurance that covers the period of stay in Korea
Visa Documents
□ Certificate of Account Balance of Sponsor or Applicant(Student) or Scholarship Certificate of the
Applicant(Student)
- Minimum Account Balance for 1 semester: USD 5,000
- Chinese national students must have USD 10,000 balance
- A photocopy of Household Register of all family members(Chinese students only)
- A photocopy of high school diploma(Chinese students only)
iii)
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For The University of Hong Kong
1.Complete Online Registration (by December 15, 2015)
2. TOEFL results / other proof of English proficiency
3. Copy of Curriculum Vitae
Visa Document
□ Training Visa Application Form ID992A, downloaded at http://www.immd.gov.hk/pdforms/ID992A.pdf, with
signature on the bottom part of ALL Pages (Page 1 to Page 4) and a recent photo, to be submitted by May
2015
□ Letter of consent for payment of visa fee, downloaded at
http://www.socsc.hku.hk/3campus/consent2016.pdf
□ Certificate of Financial Support in English version (6-month validity before arrival at Hong Kong i.e.
December 2015 onwards)
If students using parent’s bank account as financial proof, please fill in the Declaration of Bank Account
downloaded at http://www.socsc.hku.hk/3campus/bankac2016.pdf
#
Please tick as appropriate
□ YES
Are there any missing documents?
□ NO
If YES, please list the document(s) and the reason for not including them.
13. DECLARATION
A
I understand that my participation in the exchange program is conditional upon my application being reviewed
and approved by three Universities.
B.
I have noted the general points pursuant to the Personal Data (Privacy) Ordinance (Annex I) in Hong Kong.
C.
I authorize three Universities to use, check and process my data as required for my application.
D.
I understand that upon successful application, my data will become a part of my personal record and may be
used for all purposes as prescribed under relevant rules and regulations as well as attendant procedures, so
long as I remain student of the Universities.
E.
I declare that the information given in support of this application is accurate and complete.
any misrepresentation will disqualify my application.
Date:
14.
Signature:
Nomination (To be completed by program coordinator at the home institution)
Name of Institution:
Department:
Title:
Name:
I understand that
Annex I
12/602
THE UNIVERSITY OF HONG KONG
Personal Information Collection Statement
This is a statement to inform you of your rights under the Personal Data (Privacy) Ordinance.
2.
Personal information is provided by you as an applicant through the completion of application forms designated
for various purposes, e.g. for admission to a programme of study, for an exchange programme, for hall admissions, and
for provision of facilities or services. Data collected are used specifically for the purposes prescribed in the application
forms and will serve
a)
as a basis for selection of applicants;
b)
as evidence for verification of the applicant’s examination results, academic records and other information;
and
c)
where applicable, as part of the applicant’s official student records.
In the case of (c) above, information so incorporated into student files will be used for all purposes relating to the
student’s studies as required by the relevant regulations and procedures of the University.
3.
Personal data will be kept confidential and handled by the University’s staff members. The University may
transfer some of the data to an agent or other persons appointed to undertake some of its academic and administrative
functions.
4.
Under the provisions of the Ordinance, you have the right to request the University to ascertain whether it
holds your personal data, to be given a copy, and to apply for correction of the data, if deemed incorrect.
5.
Applications for access to and correction of personal data should be made by using a special request form,
and on payment of a fee in the case of data access requests. Such applications as well as requests for information
should be addressed to the Data Protection Officer, Registry, The University of Hong Kong.
H.W.K. Wai
Registrar
HWKW/RT/ml(m5156/W80)